HEALTH CARE

Republican Governors Happy With Sebelius Decision

LAS VEGAS -- Republican governors have spent two days bemoaning the Obama administration's deadline of Friday to decide whether to set up state-run health care exchanges or to allow the federal government to do it for them. But Health and Human Services Secretary Kathleen Sebelius's decision to push that deadline back to Dec. 14 gives governors more time to decide—and a lot to celebrate.

Sebelius pushed the deadline back after receiving a letter sent by Virginia Gov. Bob McDonnell, the outgoing chairman of the Republican Governors Association, and Louisiana Gov. Bobby Jindal, who was formally elected as McDonnell's successor on Thursday. The letter included 30 questions dealing with specific regulations to which the governors said they had not been provided answers.

"There are many unanswered questions from HHS, from the administration, about the operation" about the Affordable Care Act, Jindal said on Wednesday. "We have not gotten meaningful answers. I think governors deserve those actions."

After Sebelius's decision, Republicans took a victory lap.

"We appreciate the administration's acknowledgement that not enough information has been shared with governors and hope this signals a willingness to engage in meaningful dialog with governors about the policy challenges in the health care law and how to achieve some real reform," RGA spokesman Mike Schrimpf said.

Most Republicans forced to deal with the Affordable Care Act are inclined to allow the federal government set up the exchanges, which are online marketplaces where consumers will be able to shop for health insurance plans. While that may sound counterintuitive for a group of conservatives who favor states' rights, governors said the state-based option is a misleading concept.

"There is no control. When you agree to set up a state exchange, it is a state exchange in name only," Alabama Gov. Robert Bentley said in an interview.

"If you still have to cover the same things under the same conditions in the same way, whether you run a state or a partnership or a federal exchange, that's not a state exchange," said Wisconsin Gov. Scott Walker. "If I really don't have any control over that exchange, why don't I want to inform the federal government that I'm not doing a state or a partnership [exchange], but instead allow the federal government to assume the full responsibility and cost of that exchange. Because if you don't, you're potentially exposing taxpayers in your state to tremendous unknown costs in the future."

Though states now have an extra month to make up their minds, several -- like Texas and Jindal's Louisiana -- have already said they will let the feds set up their exchanges. On Thursday, the governors of North Carolina, South Carolina and Nebraska announced they would refuse to set up their own exchanges.

Others are still making up their minds. Iowa Gov. Terry Branstad told National Journal he is pursuing a multistate partnership, if he can get a waiver from Washington. Michigan Gov. Rick Snyder said he is pursuing a public-private partnership, the third option allowed under the ACA. And Virginia's McDonnell hasn't decided yet.

"Even now, because the rule-making isn't done, there's still pieces of information that my best experts in Virginia, my doctors and others who are advising me on what to do, say they can't make a prudent call between a state or a federal exchange because they don't have all the answers," McDonnell said.